Episodic Women’s Health SOAP Note Template
Patient Initials: Gender: Age: Race/Ethnicity:
Reason for Seeking Health Care:
History of Present Illness (HPI):
Current Medications (including over the counter medications):
Past Medical History (PMH):
Past Surgical History:
Family Medical History:
Review of Systems (ROS)
Focus on systems affecting women’s health and inquire about systems relevant to the reason for the visit)
Include physical exam of all relevant systems based on the reason for the visit and the HPI. Perform a cardiopulmonary exam on all patients regardless of the reason for seeking care.
Significant Data/Contributing Dx/Labs/Misc
Differential Diagnoses (3 minimum)
For each primary diagnosis, include laboratory/diagnostic tests, therapeutic/pharmacological therapy, referrals, and follow-up ordered and patient education done for this visit.
Include age-appropriate health promotion/maintenance/screening needs.
Remember that for every S (reason for the visit), there must be an O, A, and P (relevant exam, diagnosis, and plan). Always sign your notes.
DEA#: 101010101 STU Clinic LIC# 10000000
Tel: (000) 555-1234 FAX: (000) 555-12222
Patient Name: (Initials)______________________________ Age ___________
Dispense: ___________ Refill: _________________
Signature (with appropriate credentials): __________________________________________
References (must use current evidence-based guidelines used to guide the care [Mandatory])
Joseph, M. V. (2021). Episodic Women’s Health SOAP Note. Copyright ©